Inver Grove Heights Office | Hastings Office | Appointment Request | Refer a Patient Refer a Patient The first step toward achieving a beautiful, healthy smile is to schedule an appointment. To schedule an appointment, please complete and submit the request form below. Our scheduling coordinator will contact you soon to confirm your appointment. Please note this form is for requesting an appointment. If you need to cancel or reschedule an existing appointment, or if you require immediate attention, please contact our practice directly. Bold Fields are required. Practice Information Doctor Name First and Last Practice Name Your Email Address Referral Information Name of the Patient You Are Referring First and Last Patient's Phone Number Patient's Email Address Radiographs Sent? Yes No Additional Information Verification Code (case sensitive) Submit Back to Top
